Acute pain services in the United Kingdom

This survey addresses the structure and function of the acute pain services (APS) in the UK 10 years after its initial commencement. APS is now available in many hospitals (89.4%). The APS team consists mainly of anaesthetists, occasionally includes nurses and pharmacists, and rarely physiotherapists and psychologists. Anaesthetists, mainly, cover the out-of-hours service and nurses only occasionally. Dedicated medical staff sessions did not exist in 37%, and were limited to 1–2 sessions per week in 49% of the hospitals that responded to the questionnaire. Regular training commitment by medical staff did not exist in 25% of hospitals. Frequency of nursing training sessions varied from nil in 12% to almost monthly in 40% of hospitals. Patient controlled analgesia (PCA) and epidurals were available for post-operative analgesia in almost every single hospital responding to this questionnaire. Protocols for epidurals were available in 92% of hospitals, without clear relationship to the actual presence of APS. Anaesthetists designed these protocols in 27%, nurses in 1%, both anaesthetists and nurses in 43% and the whole team in 20% of hospitals. Written consent for epidurals was rarely obtained. The place of care for patients with post-operative epidural analgesia was surgical wards in 73%, HDU in 51% and ITU in 48% of respondent hospitals. The most single common factor in the decision on place of care was the availability of trained nursing staff. Monitoring usually comprised respiratory rate, sedation and pulse oximetry. Bupivacaine 0.1% was the most commonly used local anaesthetic for post-operative epidural analgesia, while diamorphine followed by fentanyl were the most commonly used epidural opioids. Other adjuvants to epidurals were rarely ever used; only clonidine was used in 7% of hospitals. Continuous epidural infusions were used in 84% of hospitals while patient controlled epidural analgesia PCEA was used only in 19% of hospitals.